The undersigned hereby submits an application to Driver Advantage Insurance, Inc. for an insurance policy, as detailed in this application, based on the statements contained herein. It is understood that if the information provided is materially false or misleading, to an extent that Driver Advantage Insurance, Inc. would have declined coverage, the policy shall be rendered null and void. The applicant acknowledges that the company may conduct an inquiry to obtain relevant information concerning the applicant's character, general reputation, financial stability (including personal credit reports), and other pertinent financial data. Additionally, personal characteristics, lifestyle, or other background information may be considered by the company in determining whether to accept or reject the applicant for coverage. Should an inquiry be conducted, upon written request, the applicant may receive further information regarding its nature and scope. The applicant acknowledges that this application is solely a request for a quotation, and neither party shall interpret any information provided herein as creating a legally binding contract for insurance.
By signing this application, I acknowledge all of the above.